Most developing country governments do not have the resources – financial, structural, technological, workforce, or otherwise – to adequately address the range of diseases in their populations. The private sector growth in the past four decades has been a response to this gap in financing and service provision: filling a need (opportunistically or philanthropically depending on the need and the provider) that would otherwise be largely unmet.

Government and donor response to health issues remains largely vertical, with donor funding and government agencies focused specifically on HIV, childhood immunization, safe delivery, diabetes, and other disease-targeted topics. The private sector is unstructured, and rarely strong enough to allow specialization. The result is that private providers at all levels are generalists, treating communicable diseases, chronic diseases, and all health conditions in between.

Generalized treatment does not mean identical treatment, and the private sector responds in very different ways to diagnosis and care for differing conditions. Driven by donor interest, much of the experience in leveraging private providers to extend access to socially desirable services has focused on reproductive health care. This has happened in part because many of the illnesses are stigmatized (STIs, abortion) and therefore health-seeking behavior is skewed towards private providers. There is also a recognition of the effectiveness of private engagement in reproductive health issues which has been built up from early experience with contraceptive social marketing.

The role of the private sector in other disease areas is equally large, but only recently appreciated. Most primary contacts with the health system occur in the private sector and so engagement has the potential to speed diagnosis, increase referrals for government-targeted programs, and improve access to care and quality of care.

We have organized the disease section into the three categories, summarizing current knowledge and programs for Communicable and Noncommunicable diseases and paying particular attention to the experiences in private sector engagement for Reproductive Health.